by Jonathan Coe
It took more than two weeks to arrange a meeting with her grandfather’s oncologist. Finally she was able to see him on the morning of the first Monday of January. He was a brusque, not to say inscrutable, consultant in his early forties: he received her not unkindly, but without letting her feel that the meeting was anything other than an unpleasant duty. He knew all about the drug she was talking about, and the first thing he said to her was:
‘Of course you know that cetuximab is an extremely expensive therapy.’
For some reason this aspect of the question had not occurred to Rachel.
‘Is it not available on the NHS, then?’
‘In certain circumstances it is, yes. But we’d have to apply for it through the Cancer Drugs Fund.’
‘Can you do that?’
‘I’m not sure I could make out a very strong case in your grandfather’s circumstances.’
‘Well, how much money are we talking about?’
The doctor consulted some notes on his desk. ‘Cetuximab is reckoned to give an ICER of £121,367 per QALY gained.’
‘Can you repeat that in English, please?’ Rachel said, after a shocked pause.
‘An ICER,’ said the doctor, ‘is the incremental cost-effectiveness ratio of a therapy. A QALY is a quality-adjusted life-year. A service like the NHS has to keep a very close eye on its costs. To put it bluntly, not every year of human life is valued as highly as every other. You have to take quality of life into account. Whatever therapy is given to him, I’m afraid your grandfather will have a low quality of life from now on.’
‘How do you work that out?’ asked Rachel.
‘Well, he’ll be bedridden, for instance.’
‘So?’
‘And he’s old.’
‘So’s my friend. The lady I know who’s taking the drug. What difference does that make?’
‘Do you know this person well?’
‘No,’ said Rachel, and then felt she had to admit: ‘I don’t know her at all, in fact. I know the person who walks her dog for her.’
‘Ah. Is she quite well-off, by any chance?’
‘Yes, she is. So what?’
‘Well, it’s possible that she paid for the treatment herself, that’s all.’ He did his best to give her an encouraging smile. ‘Look, I’ll put in the application. Of course, it will take a few weeks. These things always do. But we’ll see what gives.’
11
When she returned to Chelsea in the New Year, Rachel found that the house in Turngreet Road was much changed. Work on the basement conversion had been resumed, and the site both to the front and rear of the house was full of noise and activity.
Noise in particular. The piling rig in what used to be the back garden was working again, and all day long Rachel had to listen to its ceaseless, reverberant boom-boom-boom. She could even feel the ground shake with every impact. Also, from the window of her bedroom she now had a view of the pit, which lay open to the world (or at least to the neighbouring houses) like an inflamed, gaping wound in the landscape. It was, to her eyes, unthinkably deep. As well as a number of ladders fixed to its sides, there was an industrial hoist with a steel cage to take men and equipment down into the abyss and back up again. Miniature diggers had been lowered into the pit as well, and were presumably beavering away down there, with the spoil being carried back up along a huge conveyor, then along the belt through the front garden and out into the skips waiting in the street.
From the hoardings at the front of the house, Rachel learned that the building contractor had changed: Grierson Basements had been replaced by Nation Lloyd Sunken Interiors. The crew was now Romanian instead of Polish. The site manager, Dumitru, was a taciturn figure who nodded politely at Rachel whenever their paths crossed but otherwise had nothing to say to her. Like everybody else involved with the project, he wore a permanently anxious expression. Nobody, however, looked more anxious than the new project manager, Tony Blake, who spent most of every day locked up in his temporary site office, poring over the plans while still wearing his hard hat, occasionally emerging to have a nervous, conspiratorial word with Dumitru or to ring the front door bell in the hope of a meeting with Madiana to clarify some new element in her ever-changing, ever-expanding plans.
Despite the stress and inconvenience the works were causing her and everyone in the vicinity, Rachel could not help feeling sorry for Mr Blake. On the rare occasions he emerged from his office, he always looked so harassed, so terrified: she was constantly afraid that he was on the verge of having a nervous breakdown. One morning when she came back from the shops she found him at the front of the house, pacing up and down between the hoarding and the front steps and visibly shaking.
‘Would you like me to get you a cup of tea, Mr Blake?’ she asked him.
He took his hands away from his ears, which they had been covering in an attempt to block out the relentless noise of the piledriver.
‘Hm? What?’
‘You seem a bit … distressed. I wondered if you wanted a cup of tea.’
‘Tea? No, thank you. I’m fine. Absolutely fine.’
He did not look fine. His face was grey and his hands would not stop shaking.
‘I think I’ll get you one anyway,’ said Rachel. ‘A nice strong cup of tea with plenty of sugar.’
He said nothing in reply to this, but Rachel went to the staff kitchen to make the tea and then found, when she came back to offer it to him, that Mr Blake had returned to his office. He had a plywood desk in there, covered in architects’ drawings which had been annotated and scribbled over repeatedly in different-coloured inks. They, like everything else in the office, appeared to be in a state of total disarray.
‘Yes?’ he said, looking up in confusion when she came in.
‘I said I’d bring you some tea.’
‘Oh, thank you … Rachel, isn’t it?’
‘That’s right.’
‘Well, look, if you’ve come to complain about the noise, there’s nothing I can do. You can’t dig a hole this size in complete silence, you know.’
‘I’m not here to complain about the noise. I brought you some tea because I thought you looked a bit upset.’
She cleared a space for the mug on his desk, and set it down gently. There were two seats in the tiny office, but he didn’t ask her to sit down.
‘You … work for her, don’t you?’ he said, without touching the tea.
‘Yes.’
‘Is she …’ He swallowed. ‘Is she completely insane, do you think?’
This was the last question Rachel had been expecting to hear. ‘Lady Gunn, you mean?’
‘Yes.’
‘What makes you say that?’
At last he noticed the mug, picked it up, took a tentative sip and then a longer one.
‘I’ve worked on more than fifty basement conversions,’ he said. ‘More than fifty. All over London. But nobody has ever proposed … anything like this. Do you know –’ He looked at her directly, urgently. ‘– Do you know how deep we’re going?’
‘I’ve no idea,’ said Rachel. ‘It does seem a pretty big hole.’
‘Pretty big?’ he repeated. ‘Pretty big? She wants one hundred and fifty feet. That’s deeper than most tube stations.’
‘Is that … even possible? Wouldn’t you hit the water table at some point? Wouldn’t everything start flooding?’
‘Oh, that happened ages ago. That’s taken care of. They’ve installed three massive pumps. They’ll be running twenty-four hours a day. You see, anything’s possible, in fact. That’s precisely the problem.’ He picked up the mug a
nd took another sip, staring sightlessly ahead of him. ‘The people we took this over from quit, you know. They couldn’t stand it. And a man died. Do you hear that? A man died.’
‘Yes,’ said Rachel. ‘I heard.’
‘She doesn’t care. It hasn’t made any difference at all.’
‘A hundred and fifty feet is how many floors?’
‘It depends how high you make them, of course. And she keeps changing her mind about that, but at the current count, there are eleven.’
‘Eleven? What does she want to do with them all?’
‘That keeps changing as well. She’s given me a new set of instructions just now. About ten minutes ago. Here, why don’t you have a look? You should understand the kind of person we’re dealing with.’
Rachel sat down, finally, and drew her seat closer to Mr Blake’s desk. He scrambled around among the papers in front of him, and at last found the one he was looking for. It showed the excavation as a tall column, divided into eleven separate cross sections, each one numbered and labelled.
‘Here’s the first floor,’ he said. ‘That’s where they keep the cars, as you know. And here’s floor number two, which is going to be the children’s playroom, with a full-size bowling alley. Underneath that is the cinema. Then the gymnasium. And then we have the pièce de résistance – the swimming pool. Which is going to take up the next three floors.’
‘Three floors? Why three?’
‘Because she wants a diving board. A high one. And palm trees. Palm trees!’ He began to laugh, almost hysterical. ‘We’re going to have to get palm trees in there.’ Soon he had started shaking again, but with a few more sips of tea he managed to compose himself, and then pointed at the next level. ‘So now we’re down to level eight, which is the wine cellar. Temperature-controlled, of course. Level nine is the vault. A secure vault. You’re going to need to take a special lift to get to that one, the normal lift won’t be stopping there. Level ten – well, lucky you, that’s where you lot are going to be living. That’s the staff quarters.’
‘You mean we won’t be living in the house any more?’
‘Not above ground, no. You’d better forget about natural daylight, because you won’t be seeing much of that when this job’s finished.’
‘OK,’ said Rachel. ‘And what about this one?’ She pointed at the lowest level on the drawing. ‘Number Eleven. What’s going there?’
‘Number Eleven?’ He laughed. ‘That’s the one she told me about this morning. Number Eleven is new. She’s only just asked for it.’
‘So – what’s it for?’
‘Nothing. She can’t think of anything that she wants it for.’
Rachel frowned. ‘So why are you digging it? Why does she want it?’
‘She wants it,’ said Mr Blake, ‘because she can have it. Because she can afford it. And because … I don’t know – because no one else has an eleventh floor in their basement? Or she’s just heard about somebody who has ten and she wants to go one better? Who knows? She’s mad. These people are all barking mad.’ He took one final look at the drawing, and pointed again at level Number 11 with an unsteady finger. ‘And this is the proof.’
12
From: Val Doubleday
To: Rachel Wells
Subject:
23/01/2015 21:55
Dear Rachel
I’ve been meaning to write ever since I saw you up here a couple of months ago. Very difficult, though, to say what I have to say.
Anyway, I won’t mess around. I would have liked to say it was lovely to see you but, as I’m sure you noticed, I was far too embarrassed to feel that. In fact I will be brutally honest and say that I felt totally humiliated. As you clearly realized, I was not collecting food for my elderly next-door neighbour at all. I don’t have an elderly next-door neighbour. I was collecting it for myself.
Yes, I was on the television a few years ago. I took part in a dreadful reality show but I soon got through the money they paid me. Most of it was spent paying off debts and then I stupidly used the rest to pay for expensive studio time to record demos which no one wanted to listen to and got me nowhere. I was working in a library for a while but then the hours went down further and further until they let me go altogether. (‘Let me go’ is good, isn’t it. They’ve even got me speaking like them.) For a while after the TV thing I was diagnosed with PTSD, which entitled me to some sick pay, but apart from that I’ve just been living on jobseeker’s allowance and Council Tax support. It’s been tough, especially this winter when I’ve hardly let myself put the heating on, but this was the first time I’d ever been to a food bank. I never thought I’d find myself asking a charity for free food. Thanks to you it will be the last.
Anyway, I didn’t want to tell you about me I wanted to tell you about Alison. I said she was ‘doing fine’ but that was another lie. In fact ‘doing time’ would be more accurate. (Sorry for the rotten joke. Sometimes I think you have to laugh just because there’s no alternative.) She’s in Eastwood Park prison in Gloucestershire doing twenty-six weeks for benefit fraud. They say twenty-six but really it’s thirteen, which means she’ll be out in a few weeks now. I won’t tell you the whole story but basically she was stitched up by this bitch of a journalist called Josephine Winshaw-Eaves, who wrote a horrible, vicious article about her. (Link below.) It happened more than a year ago and it’s been a total nightmare, the whole thing. When I ran into you again she was just about to start her sentence. Of course I told her that I’d seen you and she made me swear that I wouldn’t say what had happened but as of last week I think she’s changed her mind and if you felt like visiting her I think she’d like that. You can book a visit online and I’ll give you the link at the end of this email too, but I expect you’re probably very busy with one thing and another.
Well, Rachel, you were looking well I must say – Oxford must have agreed with you – but I still don’t really understand what you were doing working in that place. Maybe I’ll find out if this means that we’re going to be back in touch again from now on. It would be nice to see your mum again. I often think of that crazy trip we took to Corfu together – ten years ago, was it? Happy times.
Love from
Val
*
THE ART OF DECEPTION
BLACK, DISABLED LESBIAN ON BENEFITS IS ACTUALLY BLACK, DISABLED LESBIAN BENEFITS CHEAT
by Josephine Winshaw-Eaves
Alison Doubleday is the archetypal paragon of modern entitlement. The kind of person the British left-liberal establishment cannot do enough to help.
After experiencing problems with her left leg as a teenager, she had a new, state-of-the-art one fitted by dedicated NHS staff at a hospital in Birmingham – despite only having lived there for a few weeks.
The minute she became eligible for Disability Living Allowance she signed on, and has been receiving it ever since. That’s in addition to the Housing Benefit she receives for the bijou three-bedroom house she shares with her lesbian lover Selena in Birmingham’s fashionable Acocks Green.
Neither of them goes out to work. Both of them claim Jobseeker’s Allowance. And yet Alison already has a job – an extremely lucrative one.
As a self-styled ‘artist’ she has created a studio in one of her bedrooms at home. Here she creates her so-called ‘political’ portraits of homeless people.
She makes them sit for hours in poses reminiscent of the great paintings of European monarchs by the likes of Titian and Van Dyck.
‘In my pictures, I try to give these dispossessed people the dignity and grandeu
r of the Kings and Queens of old,’ she says.
Needless to say, while other talented artists – whose work does not press the same political buttons – languish in obscurity, Alison’s heavily ideological portraits are much sought after by London’s chaterati.
At a private show of her work in Hoxton’s fashionable Recktall Brown Gallery last month, her pictures went on sale with a price tag of up to £20,000. Many were snapped up by the adoring crowd of champagne socialists and North London luvvies.
And what percentage of the profits did our crusading artist declare to the authorities, so that it could be ploughed back into REAL assistance for Britain’s sick and homeless?
That’s right – a big, fat zero!
Alison – the daughter of failed singer and washed-up ‘reality’ TV star Val Doubleday – was not surprisingly unavailable for comment today when we tried to contact her.
13
Faustina and Jules were from Majuro, the most populous of the Marshall Islands, a small group of coral atolls lying just north of the Equator in the Pacific Ocean. They had been working for the Gunns for a little under two years.
They were reserved, friendly and uncomplaining. If the lifestyle of Sir Gilbert, Madiana and their family seemed unusual to them, they did not comment upon it. The care they lavished on their respective charges was exemplary: Faustina made sure that the twins were clean and well presented at all times, and replenished at regular intervals; meanwhile, Jules performed exactly the same function for the cars. They rarely went out to sample the diversions that London might have offered them; all their energies were bent upon saving as much money as possible out of their earnings. In the evenings they would sit in the kitchen watching television, trying to decode the niceties of British culture from the hints that the programmes let fall. Like Rachel, like the rest of the country – like the rest of the world, it sometimes appeared – they were fascinated in particular by Downton Abbey, ITV’s big-budget soap opera following the changing fortunes of the Crawley family in post-Edwardian England. Faustina and Jules never missed an episode, and once a week would surrender themselves to the show’s high production values and its quiet, insistent, endlessly reassuring message. At the heart of this message, it seemed, was the absolute necessity of the existence of both a master and a servant class. It was understood that the master class, in particular, would always conduct itself with decency and generosity; and that although the hierarchy dividing one class from another was absolute, fellow-feeling and respectful, amicable contact between the two were not unknown. Every Sunday evening, Faustina and Jules would retire to bed having been reminded that this was the natural and indeed inevitable order of things, as much in the London of 2015 as in the troubled years between the two world wars. Whether they ever remarked upon the absence of such fellow-feeling and amicable contact in their own relationship with Sir Gilbert and Madiana, Rachel could not say.